module 5 pathophysiology

Costochondritis- disease overview

inflammation of the cartilage connecting a rib to the sternum

Costochondritis risk factors / causes

Most of the time no cause -> neurogenic inflammation, muscular imbalance

Costochondritis signs and symptoms

sharp pain at the connection -> worsened with coughing, deep breathing, or physical activity CAN MIMIC HEART ATTACK, NO EKG CHANGE

Costochondritis complications

Infection in rare cases and coughing fits

costochondritis pathophysiology

increased muscular pull on the rib

costochondritis treatments

NSAIDS (ibuprofen/acetaminophen Opioids (hydrocodone)

atherosclerosis overview

accumulation of foam cells in the arterial wall

atherosclerosis risk factors / causes

non-modifiable: age, gender (m>f), family history. Modifiable risk factors: SMOKING, HYPERTENSION, DM, sedentary lifestyle, chronic inflammation, obesity, high LDL, low HDL

atherosclerosis complications

leading cause of CAD and CVD

stable angina overview

chest pain caused by reveraible myocardial ischemia. Onset usually during periods of increased O2 demand

stable angina risk factors / causes

coronary artery disease (MCC)

stable angina signs and symptoms

sudden severe chest pain lasting < 20 minutes (average: 3-5 minutes) SELF RESOLVES. May radiate to Left arm, shoulder, neck, and jaw. Pressure/squeezing in chest, fatigue, nausea, shortness of breath

stable angina diagnostic tests

CBC -anemia. INCREASED CHOLESTEROL!!! INCREASED C-REACTIVE PROTEIN (indicates inflammation) ERYTHROCYTE SEDIMENTATION RATE- tests for inflammation

unstable angina overview

reversible myocardial ischemia

unstable angina complications

signals the approach of an impending MI

unstable angina pathophysiology

small fissure or superficial erosion of plaque causes transient thrombotic occlusion and vasoconstriction of the coronary artery (10-20 minutes)

unstable angina diagnostic criteria

CBC -anemia. INCREASED CHOLESTEROL!!! INCREASED C-REACTIVE PROTEIN (indicates inflammation) ERYTHROCYTE SEDIMENTATION RATE- tests for inflammation

NSTEMI overview

Thrombus disintegrates before complete distal necrosis has occurred and only myocardium directly beneath endocardium involved

NSTEMI risk factors / causes

cardiovascular disease

stable angina treatments

rest, nitroglycerine - dilates coronary arteries and veins

NSTEMI signs/symptoms

Partial thickness damage of heart muscle; ONLY INNER TISSUE EFFECTED

NSTEMI diagnostic criteria

EKG - ST SEGMENT DEPRESSION AND T WAVE INVERSION. ELEVATED TROPONIN I

STEMI overview

thrombus remains and myocardium involved transcends from endocardium all the way to epicardium

STEMI risk factors/causes

cardiovascular disease

STEMI signs/symptoms

Full thickness damage of heart muscle. Sudden severe chest pain with radiation down to left arm. DIAPHORESIS (PROFUSE SWEATING); WHOLE TISSUE AFFECTED

STEMI diagnostic criteria

EKG - ST SEGMENT ELEVATION. ELEVATED TROPONIN I

Left sided CHF overview

Backup in lungs -> Pulmonary edema

Left Sided CHF signs/symptoms

ORTHOPNEA, tachypnea, cough, weezing, crackles, PULMONARY CONGESTION

Left Sided CHF diagnostic

Increase BNP

Right Sided CHF overview

Backup peripherally -> Pitting Edema

Right Sided CHF signs/symptoms

CONJESTION IN SUPERIOR VENA CAVA, DEPENDENT EDEMA

Right Sided CHF complications

If right sided CHF is caused by a lun problem -> COR PULMONALE

Right Sided CHF diagnostic criteria

Increase BNP

Cor Pulmonale overview

Right sided hypertrophy and dilation with subsequent heart failure due to a respiratory disorder

Cor Pulmonale risk factors/causes

chronic lung disorders -> COPD, CF, Pulmonary fibrosis. PULMONARY HYPERTENSION

Cor Pulmonale signs/symptoms

Dyspnea, exercise intolerance, cyanosis. EDEMA, JVD IN NECK, ASCITES

Cor Pulmonale diagnostic criteria

Echocardiogram, Chest X-ray, Best test: Angiogram

Systolic Dysfunction CHF Overview

impaired contractility -> LOW EF. S3 Heart sound

Systolic Dysfunction CHF risk factors/causes

dilated cardiomyopathy

Systolic Dysfunction CHF complications

amount of blood leaving is less

Diastolic Dysfunction CHF overview

impaired filling -> NORMAL EF. S4 Heart Sound

Diastolic Dysfunction CHF risk factors/causes

hypertrophic cardiomyopathy, restrictive cardiomyopathy

Hypertrophic Cardiomyopathy Overview

LV and Septal wall thickening. 2 types: Hypertrophic Obstructive Cardiomyopathy and Hypertensive Hypertrophic Cardiomyopathy

Hypertrophic Cardiomyopathy Risk Factors/Causes

Hypertrophic Obstructive Cardiomyopathy: autosomal dominant (genetic in nature). Hypertensive Hypertriphic Cardiomyopathy: HYPTERTENSION or Valve stenosis

Hypertrophic Cardiomyopathy Signs/Symptoms

diastolic dysfunction (impaired filling) - Normal EF, S4 heart sound

Hypertrophic Cardiomyopathy Complications

Hypertropic Obstructive Cardiomyopathy: sudden death in young athletes. Hypertensive Hypertrophic cardiomyopathy - sequelae: dysrhythmias, sudden death

Dilated Cardiomyopathy Overview

All 4 chambers of the heart are dilated. Abnormally enlarged heart. Systolic Dysfunction: Low EF, S3 heart sound

Dilated Cardiomyopathy risk factors / causes

idiopathic, drug toxicity, CHRONIC ALCOHOLISM, ISCHEMIC HEART DISEASE- POST MI

Mitral Regurgitation

Systolic murmur

ASMR

Systolic Murmurs

ARMS

Diastolic Murmurs

Tricuspid Regurgitation

Systolic Murmur

Aortic Stenosis

Systolic Murmur

Pulmonary Stenosis

Systolic Murmur

Mitral Stenosis

Diastolic Murmur

Tricuspid Stenosis

Diastolic Murmur

Aortic Regurgitation

Diastolic Murmur

Pulmonary Regurgitation

Diastolic Murmur

Berry Aneurysms Overview

arterial dilation of the Circle of Willis in Brain

Berry Aneurysms risk factors/causes

MOST COMMON: HYPERTENSION, arteriosclerosis, headache, cocaine

Berry Aneurysms Signs/Symptoms

asymptomatic, headache, dizziness, Cranial nerve (3,4,5,6) compression, increased ICP

Berry Aneurysms Complications

SUBARACHNOID HEMORRHAGE. RUPTURE: "WORST HEADACHE OF MY LIFE"

Berry Aneurysms Diagnostic Criteria

CT/MRI, cerebral arteriogram

Berry Aneurysms Treatment

Decrease BP, microvascular clip

Abdominal Aortic Aneurysm Overview

arterial dilation of the abdominal aorta

Abdominal Aortic Aneurysm Risk factors/causes

vessel wall stress leads to weakening of vessel wall. HYPERTENSION, SMOKING, ATHEROSCLEROSIS

Abdominal Aortic Aneurysm signs/symptoms

asymptomatic until rupture, pain in abdomen and back

Abdominal Aortic Aneurysm Complications

RUPTURE, internal bleeding, hypovolemic shock, death

Abdominal Aortic Aneurysm Diagnostic Criteria

CT/MRI. Abdominal U/S

Abdominal Aortic Aneurysm treatment

drugs that decrease BP (Beta-Blocker).Stop smoking. Endovascular stent

Rheumatic Fever Overview

inflammatory disease due to untreated strep throat or scarlet fever

Rheumatic Fever Risk Factor/Causes

Untreated strep throat or scarlet fever causing a delayed exaggerated immune response attacking antigens in heart, muscle, joints, and brain

Rheumatic Fever Signs/Symptoms

"JONES CRITERIA": pancarditis (inflammation of all 3 layers of the heart). -infectious endocarditis: inflammation of the endocardium causing valves damage and MURMURS ( NEW ONSET). Rheumatism- joint pain and inflammation. Subcutaneous skin nodules!!!

Rheumatic Fever Treatment

antibiotics & NSAIDS with/without steroids

Rheumatic Fever Diagnostic Criteria

rapid strep test. Anti-streptolysin O antibody titer. CBC -> increased WBC. Increased CRP - inflammation

Pericarditis Overview

inflammation of the pericardium

Pericarditis Risk factors/causes

90% are viral -> could be cocksackie, influenza, hepatitis, etc.

Pericarditis pathophysiology

coming from a viral infection or an infection from a surgery

Pericarditis diagnostic criteria

EKG: PR segment depression. ST elevation without Q waves for days or weeks. CXR: WATER-BOTTLE HEART (BUZZWORD) - radiographic sign of pericardial effusion; silhouette is enlarged and in the shape of a water bottle

Pericarditis treatments

Anti-inflammatories; pericardiocentesis

Infective Endocarditis overview

infection of the endocardium

Infective Endocarditis risk factors

dental procedures (tricupsid). IV drug use (TRICUPSID). RHEUMATIC FEVER (MITRAL)

Infective Endocarditis signs/symptoms

new onset murmur. Arthritis symptoms. OSLER'S NODES, JANEWAY LESIONS, SPLINTER HEMORRHAGES, ROTH SPOTS (BUZZWORDS)

Infective Endocarditis pathophysiology

sterile bacterial vegetations on heart valves -> valve damage -> NEW ONSET REGURGITATION MURMUR

Infective Endocarditis Diagnostic criteria

blood culture. CBC ( increase or decrease WBC count)

Infective Endocarditis treatment

Antibiotics, cardiac meds. Surgical removal of infected and dead cardiac tissue or valve replacement

Giant Cell Arteritis Overview

inflammation of superficial temporal arteries

Giant Cell risk factors/causes

immune response affecting arteries

Giant Cell Arteritis Signs/Symptoms

>50 y/o. throbbing pain, visual changes, weakness, loss of appertite, JAW PAIN/FATIGUE WHILE CHEWING, BRUIT (WHOOSHING SOUND)

Giant Cell Arteritis Complications

can lead to irreversible vision loss

Giant Cell Arteritis Diagnostic Criteria

inflammation -> increased CRP, increased ESR (important fpr this pathology). Biopsy for definitive GIANT CELLS

Giant Cell Arteritis treatment

corticosteroids (1-2 years including taper)

Buerger’s Disease / Thromboangiitis Obliterans Overview

Non-atherosclerotic vasculitis of peripheral arteries and veins in the hands and feet in response to tobacco use

Buerger’s Disease / Thromboangiitis Obliterans Risk Factors

MAIN CAUSE: tobacco use. MC in 20-40 year old heavy smokers. F>M, east asia, india, middle east. Rare in AA

Buerger’s Disease / Thromboangiitis Obliterans Signs/Symptoms

first appears in fingers and toes, may progress to arms and legs. Thin, shiny skin, skin ulcers, thick/malformed nails. RAYNAUD PHENOMENON - DISCOLORED TIPS. CLAUDICATION - pain in muslces with low oxygen due to lactic acid buildup. Dry gangrene

Buerger’s Disease / Thromboangiitis Obliterans Compliations

amputation of necrotic tissue to prevent spread and more sepsis

Buerger’s Disease / Thromboangiitis Obliterans Pathophysiology

autoimmune inflammatory response from tobacco exposure. Vasculitis -> narrowing of BV lumen & increased risk of thrombi. Over time -> permanent occlusion of small-medium sized vessels -> hypoxic cell injury -> coagulative necrosis -> dry gangrene -> sepsis

Buerger’s Disease / Thromboangiitis Obliterans Diagnostic Criteria

smoker? Angiogram - look for corkscrew vessels

Buerger’s Disease / Thromboangiitis Obliterans treatment

stop smoking- earlier caught, will not happen again. Exercise -> increase blood flow. Cilostazol -> decreased vasospasm -> decreases or prevents cladication pain

Peripheral Vascular Disease overview

atherosclerotic disease of arteries perfusing limbs